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          <h1 class="post-title" itemprop="name headline">你会备牙吗——修复体的稳固和边缘问题</h1>
        

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        <p>6）前牙预备体形态不佳——不能抗垂直轴旋转的处理方案<br>a.IDS后树脂改形（活髓牙）<br>b.正畸牵引（较短的基牙）<br>c.冠延长（活髓或根管治疗）<br>d.桩核改形（根管治疗后）<br>e.选择树脂水门汀粘接系统<br>第二章 修复体结构稳固<br>第一节 修复体结构稳固的相关因素<br>a.修复体能承受咬合力而不变形的最小厚度（行使功能的前提）<br>b.预备空间及材料强度匹配（不同材料不同厚度）<br>第二节 满足修复体结构稳固的三个要点<br>1.牙合面预备<br>1）牙合面的定义及区域<br>a.定义：上下后牙咬合时发生接触的面。<br>b.区域：解剖牙合面+功能牙合面（功能尖斜面应包含在牙合面预备中，而不是独立预备的）<br>2）不同修复材料满足强度需要的厚度<br>a.金属全冠：1.0-1.5mm（功能尖1.5mm）<br>b.金属烤瓷冠：1.3-2.0mm<br>c.全瓷冠：2.0-2.5mm<br>3）牙合面预备对形态的要求及原理<br>a.按形态均匀下降（保留更多的牙体组织）<br>b.对抗水平轴翻转和垂直轴旋转<br>c.功能尖为支持尖预备空间大于非功能尖<br>d.预备体窝沟圆缓（防止应力集中）<br>4）功能尖斜面的正确认知<br>a.不是独立结构<br>b.不必独立预备<br>c.是牙合面的一部分<br>d.按功能尖预备量预备<br>e.斜度不变<br>2.轴面预备<br>a.预备量满足修复材料强度要求<br>b.预备量不足——修复体正常外形（修复体过薄）<br>c.预备量不足）修复体厚度正常（外形过大易沿水平轴翻转）<br>d.预备量过度——修复体正常外形（近髓术后敏感）<br>3.轴线角预备<br>1）轴牙线角钝缓（钝缓不等于圆）<br>2）轴轴线角钝缓（不失抗垂直轴旋转能力）<br>3）满足修复体强度减少应力集中<br>4）增加石膏模型的强度<br>第三章 边缘完整<br>第一节 边缘完成线概述<br>a.从预备体角度广义是指——肩台<br>b.从修复体角度广义是指——颈部边缘厚度<br>c.从预备体角度狭义是指——肩台外缘线<br>d.从修复体角度狭义是指——颈部边缘线<br>第二节 成功修复体边缘应具备的几个条件<br>1.与预备体的边缘完成线尽可能密合<br>2.最大限度的减少外露水门汀的宽度<br>3.必须具有足够的强度抵御咀嚼力的作用<br>4.尽可能设置在医生能够精修和检查的位置<br>5.尽可能设置在患者易于清理的部位<br>第三节 修复体边缘密合的决定性要素<br>1.预备体要有一定的锥度<br>2.轴面无倒凹<br>3.预备体肩台要足够的光滑<br>4.预备体外缘线要足够清晰光滑<br>5.修复体边缘线断面尽量为锐角<br>a.最好的冠修复体也会有就位差（制作工艺和水门汀膜厚度）<br>b.直角肩台的预备体和修复体边缘孔隙最大<br>c.预备体牙合面及轴面就位差相等。<br>d.修复体边缘断面略小于90度时肩台外缘间隙不变<br>第四节 临床上各类边缘线的特点和对应工具<br>1.直角肩台<br>1）适应症：适合全瓷冠及具有肩台瓷的金属烤瓷冠<br>2）优点：足够厚度不易折裂<br>3）对应工具：平头直角车针<br>4）缺点：a.对密合度及水门汀要求流动性高；b.对牙体组织磨除较多。<br>2.直角+斜面肩台<br>1）适应症：前牙或后牙的金属烤瓷冠<br>2）优点：利于全冠的就位和边缘密合性<br>3）对应工具：平头直角车针+火焰状车针<br>4）缺点：a.磨除更多的牙体组织；b.临床操作较难尤其邻面；c.技师制作较难容易变形。<br>3.90度圆角肩台<br>1）适应症：全瓷冠<br>2）优点：修复体边缘厚水门汀流动性好<br>3）对应工具：平头圆角车针<br>4）缺点：a.磨除更多的牙体组织；b.可能伤及牙髓<br>4.90度圆角肩台+斜面<br>1）适应症：前后牙的金属烤瓷冠<br>2）优点：有利于冠就位和密合性<br>3）对应工具：平头圆角车针+火焰状车针<br>4）缺点：a.磨除更多的牙体组织；b.临床操作太复杂；c.邻面肩台制备困难。</p>
<p><strong>个人总结：前牙形态不佳的改善方案。修复体结构稳固的问题，由合面预备、轴面预备、轴线角预备三个因素决定。修复体边缘完整的问题，边缘完整的要求，常用的边缘形式的适应症，优缺点等。</strong></p>
<p>我发文章的四个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的博客园博客地址： <a target="_blank" rel="noopener" href="https://www.cnblogs.com/zwdnet/">https://www.cnblogs.com/zwdnet/</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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